Rutgers, The State University of New Jersey Liberty Plaza, 335 George Street, New Brunswick, NJ 08901 rwjms.rutgers.edu/boggscenter p. 732-235-9300 f. 732-235-9330 Joan B. Beasley, PhD Research Associate Professor Director, Center for START Services Institute on Disability, University of New Hampshire Concord, NH Addressing the Mental Health Needs of Individuals with IDD and Their Families: The START Crisis Prevention and Intervention Program September 27, 2019 APA Hotel Woodbridge, Iselin, NJ The attached handouts are provided as part of The Boggs Center’s continuing education and dissemination activities. Please note that these items are reprinted by permission from the author. If you desire to reproduce them, please obtain permission from the originator.
36
Embed
Joan B. Beasley, PhDrwjms.rutgers.edu/.../documents/...17-19packet.pdf · Joan B. Beasley, PhD Research Associate Professor Director, Center for START Services Institute on Disability,
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Rutgers, The State University of New Jersey Liberty Plaza, 335 George Street, New Brunswick, NJ 08901
rwjms.rutgers.edu/boggscenter p. 732-235-9300 f. 732-235-9330
Joan B. Beasley, PhD Research Associate Professor
Director, Center for START Services Institute on Disability, University of New Hampshire
Concord, NH
Addressing the Mental Health Needs of Individuals with IDD and Their Families: The START Crisis Prevention
and Intervention Program
September 27, 2019 APA Hotel Woodbridge, Iselin, NJ
The attached handouts are provided as part of The Boggs Center’s continuing education and dissemination activities. Please note that these items are reprinted by permission from the author. If you desire to reproduce them, please obtain permission from the originator.
"Time after time, I have found that when people are taken seriously, when they are respected, when their behavior is interpreted, understood and responded to accurately, when they are engaged in mutual dialogue rather than subjected to unilateral schemes of 'behavior management,' somehow as if miraculously, they become more ordinary. I know a number of people who have had severe reputations who have shed them when those supporting them listened more carefully."
IDD and Mental Health Conditions• Across the United States approximately 1.5% to 2.5% of the population has
an intellectual developmental disorder (IDD).
• The (DSM5) defines IDD as a disability that involves impairments of general mental abilities that impact adaptive functioning in three domains, or areas.
• These domains determine how well an individual copes with everyday tasks.
• Epidemiological studies have established that the incidence and prevalence of mental health conditions for people with IDD is typically 2 to 3 times that of the general population
• and that these mental health conditions often contribute to challenging behavior. For people with IDD, aggression and self-injurious behavior are two of the most common reasons for referrals for mental health services.
• "Troublesome" behaviors considered unacceptable in many support and service venues
• The last and least served
• Continued concept of “primary” vs. “secondary” disorders: were not trained in MH or health practices that could contribute to challenging behavior were sent to be “fixed”
• PLCs• Professional practice improvement groups• Coaching• Technical Support: office hours• Certification (coordinators and program)• National Online Training Series• Certification Course• Fidelity Guides• START Curricula MH/IDD training lifespan • CETs• START National Training Institute
UNH/IOD Center for START Services: Building capacity and evidence based
Fidelity –provide training and consultation to support the integrity of activities that make the START Model effective and directly impact the success of desired outcomes. The START model is not a just a compilation of what is known in the field, it is a community of practice with very specific methods and validated tools
START method:A Crisis is a Problem without the Tools to
Address it• We are a tertiary care crisis intervention model• The importance of a safety net • The tools to discovering the strength in all of us• The tools to cross systems collaboration• The tools to understand and collaborate in times of
difficulty• The tools to promote wellness and well being • It is not about the pill or the plan it is about the person and
Wellness Based - The World Health Organization defines wellness as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmary.
Each of the approaches used and endorsed by the START model are effective best practices. Because they are interrelated, outcomes are strongest when they are combined and used across all aspects of START service delivery.
START ApproachesStrengths-Based practice builds on the positive psychology premise that all people have inherent strengths and skills that promote resiliency and resourcefulness in the face of challenges.
Cultural and Linguistic competency: Incorporated into person & family-centered approach to planning and service delivery fostering mutual respect, seeking a common understanding, shared experiences and partnerships between service providers and individuals and families receiving services.
Leadership and dialogue employing Systemic Consultation - The START model conceptualizes presenting solutions to problems within the context of the system in which the person lives, works, and interacts with their environment.
Bio-psycho- social integrated health approach to wellness and well being: comprehensive rigorous standards for assessment and treatment, continuous learning.
Crisis prevention and intervention planning and response across system of support to ensure effective and strength based interventions, collaboration and cooperation and timely response in time of difficulty
We perform best through our collective intelligence
“As long as everyone got a chance to talk, the team did well. But if only one person or a small group spoke all the time, the collective intelligence declined”
• Hospital Emergency Rooms• Police• Other First Responders
Advisory Committee
• Director (master's or above)• Clinical Director (Psychologist or equivalent)• Medical Director (Psychiatrist or APRN)• Certified START Coordinators• Team Leader
The Center for START Services
• Customized Coaching• Technical Support• Certification of START Coordinators• National Online Training Series• Online Certification Course for START
Teams• National Database• Fidelity Guides• START Curricula
START Regional Team Services
Clinical Services
• Neurology• OT• Forensic Psychology• Nursing• Dentistry• Family Supports
Training and Consultation
• Didactic Training• Eco-mapping and systems support• Crisis prevention and intervention planning• Emotional Intelligence training
• Receive 60 hours of didactic training and supervision in national educational forums
• Certification renewed every two years• Systems linkage approach• Trained leaders in the field• Provide assessment, consultation • Trained trainers • CET and CSE development • All members of the clinical team are certified START
• The START Network is a group of individuals with a common repertoire of knowledge about the ways of addressing similar (and often shared) problems and purposes.
• This collective practice is made accessible to newcomers through the START training forums: activities through which individuals develop ways of thinking and reframing their views.
• The apprenticeship of START coordinators is aimed to reproduce practices through which the next generation START coordinators is developed. We need to teach coordinators to act like START coordinators.
START Model Program Service24-hour Community-Based Crisis Response
• Integrated into the overall system, use a multidisciplinary team approach, and be able to communicate effectively; Working with inpatient units, mobile crisis teams, emergency rooms
• Crisis Evaluation, Prevention, Intervention, and Stabilization: START Center
• 24-hour access to care providers for assistance
• Discharge planning meetings within 24 hours with START Coordinators linked with in-home services, inpatient and START Resource Centers
• Use the specified tools of START model; validated and researched instruments
The challenge for START coordinators is to become professionals that help to solve problems with no easy answers and that requires judgment and discretion.
START fidelity requirements are aimed to frame a language to define START for new members to become acculturated and internalize the conventions of participation.
• We all have multiple cultural identities (including the system in which we reside)
• Language and words matter • They are all layered in differing ways due to our experiences• Different conditions draw on these layers• These are key to understand for START programs to help
Training for Creative Thinking, Collaboration, and Complex
Problem Solving
• Coordinators must be prepared to work in complex and uncertain contexts that demand autonomy, judgment, and the ability to solve problems in action on the spot.
• Innovation and creative thinking are critical skills.
Teaching START Practices developed and implemented by CSS
• START coordinators are encouraged to make the link between knowing and doing through practice and reflective processing. This is the intent of our methods professional practicum (through practice groups, live supervision, apprenticeship, and coaching).
• While providing the needed didactic information, we are implementing an alternative model of teaching to incorporate START practices and acculturation into training forums in order to create more independent and creative coordinators.
Bio-Psycho-Social approach (Engel, 1979) considers the biological, psychological and social strengths and vulnerabilities related to mental wellness and how these different factors might contribute and impact one another.
Engel, G. (1979). The biopsychosocial model and the education of health professionals. General Hospital Psychiatry, 1(2), pp.156-165.
• Shift in perception, reframe and refocus• There is more than one way to view a situation• Optimism can be taught• If you practice these skills you will be more effective in all
elements in your life• If you use these practices with teams, it will have an impact
• Integrated into the overall system, use a multidisciplinary team approach, and be able to communicate effectively; Working with inpatient units, mobile crisis teams, emergency rooms
• Crisis Evaluation, Prevention, Intervention, and Stabilization: START Center
• 24 hour access to care providers for assistance
• Discharge planning meetings within 24 hours with START Coordinators linked with in-home services, inpatient and START Resource Centers
• Part of follow-up to prevent the need for crisis services• Skill building for provider• Outreach with START Coordinator to monitor and modify
plans as needed• Support to implement PBSP and other plans• Transitional support after hospital or Center stay• Training and consultation provided• Two to four hours a week• Can be scheduled to occur on a regular basis as identified in
(3-5 days)• Keeping families together• Practicing new strategies• Transitioning from more restrictive settings• Developing new skills• Ongoing assessment to insure stability• Medication changes/modifications• Familiarity to insure safety net• Supporting families and systems in crisis
• “Guests”• Focus on positive psychology, positive characteristics from
the time of admission and throughout the stay• Sensory reduction room for people with autism and others• All activities can be conducted in home• Trauma informed approach• Communication and collaboration with host home and
• To provide a productive and positive environment • To promote healthy lifestyle (diet and recreational fitness)• To teach people skills, coping strategies • To support the desire to deal with frustration that is an
inevitable part of life• Provide the support caregivers and people with disabilities
• Utilizes the creative process to help communicate feelings• Provides support to express and explore feeling• Allows for self-expression• Provides a structure for constructive engagement with
Background• Surprisingly little research on the use of inpatient psychiatric care
among those with ID exists in the US• In countries with structured national healthcare initiatives, such as
the UK and Canada, more research has been conducted.• This literature suggests those with ID have greater rates of
psychiatric hospitalization and longer stays. Factors associated with increased use include:o Milder levels of ID,o Younger age and male gendero Aggressiono Psychotic/schizophrenia disorderso Autism Spectrum Disorder (ASD) o Use of psychotropic medications, particularly polypharmacy
The Center for START Services is a program of the University of New Hampshire Institute on Disability/UCED
www.centerforstartservices.org
Improvement in Mental Health Outcomes and Caregiver Service Experiences Associated with START Clinical Team ServicesLuke Kalb, PhDJoan B. Beasley, PhDAndrea Caoili, MSWAnn Klein, MA
Study Hypotheses• A trend towards improvement across each aim.
• Based on prior research*, changes in caregiver service experiences and hospitalization/ED use may require longer periods of observation given the known difficulties in making systemic changes
*Beasley J. B., ed. Trends in coordinated and planned mental health service use by people with dual diagnosis. Kingston, N.Y.: NADD; 2002. Contemporary Dual Diagnosis: MH/MR Service Models, Volume II: Partial and Supportive Services.
• The ABC is a heavily cited and psychometrically soundmeasure of psychiatric symptoms for both adults and youthwith ID.
• The ABC consists of 40-items across five subscales. Three ofthe five subscales – the Irritability, Lethargy, andHyperactivity subscales – were employed in this study.
• Improvements in caregivers’ perceived inclusion in their dependents care and how responsive the mental health system was when they expressed their concerns.
• All elements of START, especially START coordination and outreach, are designed to include caregivers in their dependents care whenever possible.
• Significant improvement in the two aforementioned constructs substantiate a primary goal of START: to listen, support, and respond to the person who knows the individual best
• Improvements in the perceived quality of services provided directly to the caregivers’ dependent
• Findings suggest START can improve both the access and appropriateness of services.
• Enhancing the quality of care that is afforded to the individual with IDD - through services such as medical/clinical consultation, crisis planning and intervention, provider education and linkage agreements –is another principle goal of START
• Directly targeted by cross systems crisis plans, START crisis response, and consultation services.
• The influence of these interventions can be seen in the significant improvements in knowing who to call during times of crisis, support during crisis, and assistance on nights and weekends (from the FEIS).
• These findings, alongside a reduction of inpatient admissions and ED visits, are promising in terms of supporting those with the greatest needs.
• The objectives of this study were to examine changes in: 1) mental health symptoms 2) rates for emergency psychiatric service use in a sample of individuals with ID served by a midwest START team.
• Participants were enrolled for an average of 430 days (min = 239, max = 642, SD = 115).
• At the time of enrollment, most of the sample lived in supported community settings (70%). Other study participants resided at home with family (7%), lived independently (7%), resided in locked facilities (9%), or had some other living arrangement (7%).
Our mission is to advance research efforts that seek to improve the lives of individuals with Intellectual/Developmental Disabilities (IDD) and behavioral health needs and their families.
Committee Goals
Inspire and support START network members to conduct and consume research that addresses the needs of the population we serve.
Provide consultation services and discretionary funding to help START programs develop and launch independent research projects.
Connect parties within and across the START network and its affiliates who share similar research interests.
Disseminate research related to START and individuals with IDD and behavioral health needs and provide regular updates on all research initiatives.
Kalb, L. G., Beasley J., Caoili, A. (2019). Improvement in Mental Health Outcomes and Caregiver Service Experiences Associated with a START Program. Journal of American Intellectual and Developmental Disabilities, 124(1), 25-34. Beasley, J., Kalb, L.G., Klein A (2018). Improving Mental Health Outcomes for Individuals with Intellectual Disability through the Iowa START (I-START) Program. Journal Of Mental Health Research in Intellectual Disabilities. ISSN: 1931- 5864 (Print) 1931-5872 Kalb, L. G., Beasley J., Klein, A., Hinton, J. & Charlot, L. (2016). Psychiatric hospitalization among individuals with intellectual disability referred to the START crisis intervention and prevention program. Journal of Intellectual Disability Research, 60(12), 1153-1164. Charlot, L. & Beasley, J. (2013). Intellectual Disabilities and Mental Health: United States-Based Research. Journal of Mental Health Research in Intellectual Disabilities, 6 (2), 74-105. Beasley, J. (Ed.) (2007). U.S. Public Policy: Assessment of Services for Individuals with Developmental Disabilities and Mental Health Needs [Special issue]. Mental Health Aspects of Developmental Disabilities, 10(3). Beasley, J. (2004). Importance of Training and Expertise to Assess “What Works” for Individuals with Intellectual Disabilities. Mental Retardation, 42(5), 405-406. Beasley, J. & Hurley, A.D. (2003). The Design of Community Supports for Individuals with Developmental Disabilities and Mental Health Needs. The Mental Health Aspects of Developmental Disabilities, 6(2), 81-85. Beasley, J. & DuPree, K. (2003). A systematic strategy to improve services to individuals with coexisting developmental disabilities and mental illness: National trends and the "Connecticut Blueprint." Mental Health Aspects of Developmental Disabilities, 6, 50-58. Beasley, J. (2000). Family Caregiving Part III: Family Assessments of Mental Health Service Experiences of Individuals with Mental Retardation in the Northeast Region of Massachusetts from 1994 to 1998. Mental Health Aspects of Developmental Disabilities, 3(3). Beasley, J. (2000). Why Individualized Habilitative Plans May Fail: When Challenging Behaviors are Symptoms of a Psychiatric Disorder.” Mental Retardation, 38(2), 179. Beasley, J. & Kroll, J. (1999). Family Caregiving Part II: Family Caregiver-Professional Collaboration in Crisis Prevention and Intervention. Mental Health Aspects of Developmental Disabilities, 2(1), 22-26. Beasley, J. (1998). Long-term co-resident caregiving in families of persons with a dual diagnosis (Mental Illness and Mental Retardation). Mental Health Aspects of Developmental Disabilities, 1(1), 10-16.
Krauss, M. W., Gulley, S., Sciegaj, M., & Wells, N. (2003). Access to specialty medical care forchildren with mental retardation, autism, and other special health care needs. MentalRetardation, 41(5), 329–339. doi:10.1352/0047-6765(2003)41<329:ATSMCF>2.0.CO;2
La Malfa, G., Lassi, S., Bertelli, M., Salvini, R., & Placidi, G. F. (2004). Autism and intellectualdisability: A study of prevalence on a sample of the Italian population. Journal ofIntellectual Disability Research, 48(3), 262–267. doi:10.1111/j.1365-2788.2003.00567.x
Loch, A. A. (2014). Discharged from a mental health admission ward: Is it safe to go home? Areview on the negative outcomes of psychiatric hospitalization. Psychology Research andBehavior Management, 7, 137–145. doi:10.2147/PRBM
Lunsky, Y., Paquette-Smith, M., Weiss, J., & Lee, J. (2014). Predictors of emergency servicesue in adolescents and adults with autism spectrum disorder living with family. EmergencyMedicine Journal, 32(10), 787–792.
Mandell, D., Xie, M., Morales, K., Lawer, L., McCarthy, M., & Marcus, S. (2012). Theinterplay of outpatient services and psychiatric hospitaLarryation among Medicaid-enrolled children with autism spectrum disorders. Archives of Pediatric & AdolescentMedicine, 166(1), 68–73. doi:10.1001/archpediatrics.2011.714
Marrus, N., Veenstra-Vanderweele, J., Hellings, J. A., Stigler, K. A., Szymanski, L., King, B.H., . . . Pruett, J. R., Jr.; ; (2014). Training of child and adolescent psychiatry fellows inautism and intellectual disability. Autism, 18(4), 471–475. doi10.1177/1362361313477247
McCarthy, J., Hemmings, C., Kravariti, E., Dworzynski, K., Holt, G., Bouras, N., &Tsakanikos, E. (2010). Challenging behavior and co-morbid psychopathology in adultswith intellectual disability and autism spectrum disorders. Research in DevelopmentalDisabilities, 31(2), 362–366. doi:10.1016/j.ridd.2009.10.009
Salomon, C., & Trollor, J. (2017). Young people with an intellectual disability experience poorerphysical and mental health during transition to adulthood. Evidence-Based Nursing, 21, 20.
Salzer, M. S., Kaplan, K., & Atay, J. (2006). State psychiatric hospital census after the 1999Olmstead Decision: Evidence of decelerating deinstitutionalization. Psychiatric Services, 57(10), 1501–1504. doi:10.1176/ps.2006.57.10.1501
Scott, K.M., Bruffaerts, R., Simon, G. E., Alonso, J., Angermeyer, M., DeGirolamo, G., & Kessler, R.C. (2008). Obesity andmental disorders in the general population: Results from the worldmentalhealth surveys. International Journal of Obesity, 32(1), 192–200. doi:10.1038/sj.ijo.0803701
Siegel, M., & King, B. H. (2014). Autism and developmental disorders: Management ofserious behavioral disturbance. Child and Adolescent Psychiatric Clinics, 23(1), xiii–xv.doi:10.1016/j.chc.2013.08.007
Weiss, A., Barrett, M., Heslin, K., & Stocks, C. (2006). Trends in emergency department visitsinvolving mental and substance use disorders, 2006–2013: Statistical brief# 216. Rockville,MD: Agency for Healthcare Research and Quality.
Wharff, E. A., Ginnis, K. B., Ross, A. M., & Blood, E. A. (2011). Predictors of psychiatricboarding in the pediatric emergency department: Implications for emergency care.Pediatric Emergency Care, 27(6), 483–489. doi:10.1097/PEC.0b013e31821d8571
Wilkins, D. (2012). Ethical dilemmas in social work practice with disabled people: The use ofphysical restraint. Journal of Intellectual Disabilities, 16(2), 127–133. doi:10.1177/1744629512444986
Zablotsky, B., Kalb, L. G., Freedman, B., Vasa, R., & Stuart, E. A. (2014). Health careexperiences and perceived financial impact among families of children with an autismspectrum disorder. Psychiatric Services, 65(3), 395–398. doi:10.1176/appi.ps.201200552